Telemedicine as a stand-alone, episodic care service rarely meets expected standards

The College views telemedicine as a potentially powerful adjunct to integrated primary care and specialty services. Examples of effective use of telemedicine in BC include primary services to remote First Nations communities in the central interior and health authority-based specialty consultative services. Crucial elements include consistent staff to provide longitudinal care to patients they come to know, and the availability of closely affiliated settings for short-notice, face-to-face assessment, when required.  

The Inquiry Committee continues to receive allegations of deficient care provided via telemedicine in models that amount to virtual walk-in clinics. At a recent meeting, the committee reviewed the care of five patients provided by four registrants. The medical director for the service was also asked to respond and an independent expert was engaged. Clinical presentations included a child with pharyngitis, a child with persistent pain affecting a single joint, an adult with back pain, and women seeking an oral contraceptive in one case and a vaginitis remedy in another. The committee concluded its review with criticism of the assessment and management of three of the five patients. Feedback will be provided to the registrants and the medical director will be interviewed.

While acknowledging that the statutory authority of the College is limited to case-by-case investigations of registrant performance, the committee concluded that it is almost impossible for physicians to meet expected standards for the majority of patients presenting with episodic concerns in this fashion. Services like telemedicine should be affiliated with and supported by full-service primary care clinics. Many patients presenting with acute concerns will require physical assessment that exceeds the functionality of the telemedicine interface. In primary care, telemedicine is likely to find its main utility in follow-up visits, to assess patient progress and review the results of tests.

The College looks forward to the widespread adoption of telemedicine by comprehensive family practice groups as a means of improving productivity and providing greater convenience and access to their patients. This will clearly become standard practice in the near future. Based on evidence reviewed by the Inquiry Committee to date, the care of unattached strangers in virtual walk-in clinic models is to be discouraged.

The College standard on Telemedicine can be found here.